Effects of rotigotine on sleep in Parkinson's disease patients: A Parkinson's Kinetigraph study

Sotirios Grigoriou^1,2Carin Janz^1,2*Malcolm Horne^3,4Filip Bergquist^5,6Nil Dizdar⁷Per Odin^1,2

• ¹Lund University, Lund, Skane County, Sweden
• ²Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Skane County, Sweden
• ³St Vincent's Hospital (Melbourne), Melbourne, Victoria, Australia
• ⁴Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
• ⁵Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
• ⁶Sahlgrenska University Hospital, Gothenburg, Sweden
• ⁷Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Östergötland, Sweden

Recent studies suggest that the dopamine agonist (DA) rotigotine improves sleep among Parkinson disease (PD) patients. Parkinson's Kinetigraph (PKG) offers a home-based alternative for evaluating sleep. We investigated the effect of rotigotine on sleep in PD patients with PKG and questionnaires. Secondarily, the effects of rotigotine on daytime sleepiness, motor symptoms, quality of life and correlations between PKG variables and rating scale results were investigated.Method: 32 PD patients with sleep disturbances (Clinical Global Impression-Severity (CGI-S) ≥ 3) were included in this observational study. Before start of treatment and during stable dose with rotigotine patients were assessed with Parkinson's disease sleep scale 2 (PDSS-2), Epworth Sleepiness Scale (ESS), Parkinson's disease quality of life questionnaire (PDQ-8), European Quality of life five dimensions (EQ-5D-5L) questionnaires and PKG recordings (24h/day for 6 days). Clinicians evaluated sleep using CGI scales, and PD severity using Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD).Results: Rotigotine did not significantly improve total PDSS-2 or PKG nighttime scores in the entire group, but PDSS-2 improved among patients with PDSS-2 ≥18 at baseline and for DAnaïve patients (p=0.009 and p=0.013). Treatment improved percent time tremor (PTT; p<0.001), percent time immobile during daytime (PTID; p<0.001), CISI-PD (p<0.001), PDQ-8 (p=0.014), and EQ-5D-5L (p=0.002). No significant correlations were found between PTID and ESS-total (ρ=-0.046, p = 0.718) or between combined sleep score (CSS) and PDSS-2 total (ρ=-0.065, p = 0.612).Conclusions: Rotigotine improved sleep in patients with a baseline PDSS-2≥18 and in DA-naïve patients, but not in the whole study group. Additionally, rotigotine seemed to improve motor function and quality of life. PTID improved with treatment, suggesting rotigotine to decrease daytime sleepiness. Whether the improved PTID reflects a positive impact on daytime sleepiness or just improved mobility and to what extent PKG nighttime scores accurately represent sleep variables remains to be investigated in further studies.